PatientsVille.com

Primary Insomnia | The Role of Partial Reinforcement in the Long Term Management of Insomnia

Primary Insomnia research study

What is the primary objective of this study?

The lack of scientific attention devoted to the placebo effect as a phenomenon in its own
right probably reflects the paucity of theoretical positions within which to organize the
existing data and design new research. The proposed investigation 1) is an attempt to advance
from a descriptive to an experimental analysis of the placebo effect, taking into account
classical conditioning effects, and 2) examines the clinical implications of partial
reinforcement as it is applied to the treatment of insomnia. Subjects with primary insomnia
will be treated with zolpidem for a period of one month and then randomized to one of four
groups for a period of 12 weeks: one receiving full dose zolpidem on a nightly basis
(continuous reinforcement), one receiving full dose zolpidem on 14 of 28 nights where placebo
is provided on non-drug nights (partial reinforcement), one receiving full dose zolpidem on
14 of 28 nights where no pills are imbibed on non-drug nights (intermittent dosing), and one
receiving 5 mg dose zolpidem on a nightly basis (continuous reinforcement with half the
standard dose). Following treatment, subjects will be entered into an extinction protocol
during which they will 1) continue on the schedule assigned during the experimental period,
2) receive only placebo, or 3) receive neither drug nor placebo. Sleep and daily functioning
will be monitored on a daily basis via sleep diaries for the duration of the study. It is
hypothesized that, holding cumulative dose constant, a partial schedule of reinforcement will
enable patients to better maintain their clinical gains as compared to subjects that receive
either continuous reinforcement with half the standard dose or half the frequency of use.
Relevance: The proposed research is not an attempt to offer a behavioral alternative to drug
treatment; it is an attempt to acknowledge and capitalize on a behavioral dimension in the
design of drug treatment protocols. The value of the proposed research resides in its
capacity to provide for the long term treatment of insomnia in a manner that increases the
durability of pharmacotherapy while reducing the overall amount of medication required. If
proven effective in the current application, this new approach to pharmacotherapy and placebo
effects is likely to stimulate new interdisciplinary research for the treatment of a variety
of chronic diseases.

Who is eligible to participate?

Inclusion Criteria:
- Patients with insomnia will meet RDC criteria for psychophysiologic insomnia(99).
These criteria are provided in Appendix 2. In addition, the complaint of disturbed
sleep will have one or more of the following characteristics:
- > 30 minutes to fall asleep (Initial Insomnia)
- 2 awakenings per night of >15 minutes duration and/or wake after sleep onset time
of > 30 minutes (Middle Insomnia)
- An awakening of > 30 minutes prior to the desired \"wake up\" time (Late Insomnia)
- Any two of the above complaints (Mixed Insomnia)
Additionally, total sleep time will not exceed 6 hours (unless the sleep efficiency
quotient is < 80%) and the problem frequency must be equal to or greater than 4 nights/
week (severe insomnia) with a problem duration > 6 months (chronic insomnia). This profile
must be evident at both intake (based on retrospective reports) and as an average profile
from the two weeks of baseline diaries (based on prospective sampling).
Exclusion Criteria:
- Unstable medical or psychiatric illness Assessed with the Mini International
Neuropsychiatric Interview (MINI) and the The Schedule for Affective Disorders and
Schizophrenia-Lifetime Version (SADS-L) To assure that the insomnia is not secondary
to these factors
- Symptoms suggestive of sleep disorders other than insomnia Assessed with the SDS-CL To
assure that the insomnia is not secondary to these factors
- Polysomnographic data indicating sleep disorders other than insomnia Assessed with PSG
in collaboration with our sleep medicine consultants To assure that the insomnia is
not secondary to these factors
- History of head injury with a sustained loss of consciousness Assessed by self report
during the Intake Interview To help assure that the EEG measures are unconfounded by
brain damage
- Evidence of active illicit substance use or fitting criteria for alcohol abuse or
dependence Assessed with a structured psychiatric interview schedule (the MINI) ,
written versions of clinical interview queries regarding alcohol use, abuse and
dependence (the AUDIT and CAGE), the toxicology screen which is part of the clinical
chemistries obtained during the screening physical. To assure that the insomnia is not
secondary to these factors and to assure that substance use/abuse does not confound
treatment.
- Use of CNS active medications, antidepressants, and hypnotics other than zolpidem
Assessed by self report and from the toxicology screen which is part of the clinical
chemistries obtained during the screening physical. To help assure that the clinical
effects observed in this study are due to the study medication and schedule of
reinforcement.
- Inadequate language comprehension Informally, assessed by the Clinical Research
Coordinator during Intake Interview To assure the quality of self report data as all
the measures are in English.
- Pregnancy Assessed by self report and from the clinical chemistries data obtained
during the screening physical. Excluded so as to 1) prevent the fetus from exposure to
the study medication (although it should be noted that the medication is considered
FDA pregnancy category B) and 2) control for the biopsychosocial changes that occur
with pregnancy and may alter the response to the study medication and schedule of
reinforcement.
- No first-degree relatives with bipolar disorder or schizophrenia Assessed by self
report and a structured psychiatric interview schedule (the SADs). Excluded to reduce
risk for first onset during the study

Study Interventions

Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.

Drug:Zolpidemsedative-hypnotic

Drug:PlacebosPlacebo

Study Arms

Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.

Discuss Ambien

If you think you may have a medical emergency, call your doctor or 911 immediately.

By accessing this website, you are indicating your acknowledgement and acceptance of these Terms of Use. These Terms of Use are subject to change by WinFirst LLC at any time in its discretion. Your use of WinFirst LLC Site after such changes are implemented constitutes your acknowledgement and acceptance of the changes. Please consult these Terms of Use regularly.
PatientsVille.com does not provide medical advice, diagnosis or treatment. The information contained on PatientsVille.com site has not been scientifically or otherwise verified as to a cause and effect relationship and cannot be used to estimate the incidence of adverse drug reactions or for establishing or changing of patient treatments.